Provider Demographics
NPI:1972139764
Name:JENNIFER A HATHAWAY DDS PA
Entity type:Organization
Organization Name:JENNIFER A HATHAWAY DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FESTER
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:979-776-6884
Mailing Address - Street 1:1719 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5210
Mailing Address - Country:US
Mailing Address - Phone:979-776-6884
Mailing Address - Fax:979-774-3008
Practice Address - Street 1:1719 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5210
Practice Address - Country:US
Practice Address - Phone:979-776-6884
Practice Address - Fax:979-774-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment